Digital Adrenaline Injection Injuries: A Case Series and Review

MW ElMaraghy, AW ElMaraghy, HB Evans. Digital adrenaline injection injuries: A case series and review. Can J Plast Surg 1998;6(4):196-200.

Accidental digital adrenaline autoinjection is an uncommon injury, with only a few case reports existing in the literature. A six-case series of digital EpiPen injection injuries, a review of the literature and treatment protocols with their pathophysiological and pharmacological basis are presented. Oral nifedipine, topical 2% nitroglycerine paste, digital block using lidocaine and warm water immersion are ineffective in acutely reversing digital ischemia. Clinical and experimental evidence demonstrating spontaneous resolution of digital vasospasm may support the expectant management of these injuries. If medical intervention is undertaken, safe and rapid reversal of adrenaline-induced digital ischemia can be achieved with local and/or regional infiltration of phentolamine mesylate. Based on a review of the current case series and the literature, the authors’ preferred method of treatment includes simultaneous digital block with a mixture of phentolamine and 2% lidocaine and local injection of phentolamine at the puncture site. Initially, the authors suggest using 5 mg phentolamine mesylate in 2 mL of 2% lidocaine, and injecting 1 mL (2.5 mg) of the solution into the ulnar and 1 mL (2.5 mg) into the radial aspect of the base of the involved digit, followed by injecting the injury site with a 5 mg/mL solution of phentolamine.